Health Connection - January 2021

The COVID-19 Vaccine: Our Best Shot at Ending the Pandemic

By Sherah Bateman, MPH, MS, CIC

As the pandemic continues, it is exciting and encouraging that distribution of the much-anticipated COVID-19 vaccines has begun, and that more of the population will have access to immunization in the coming weeks and months. Unfortunately, there’s a lot of misinformation about the vaccines circulating on social media and even in some news reports. To help separate rumor from reality, we’ve addressed some of the common misconceptions that are making the rounds.

• Myth: The vaccine uses a live version of COVID-19.
  Fact: The COVID-19 vaccine does NOT use the live COVID-19 virus. Instead, the vaccine uses scientific techniques to train the human body to recognize and fight COVID-19 by either introducing a harmless piece of the virus (not the entire germ) to the body or by giving the body instructions to make its own COVID-19-like protein. The body then recognizes these proteins shouldn't be there and produces antibodies to fight them off. Then, the immune system establishes memory to protect against future infections if a person is exposed. Learn more about how the vaccines work.
• Myth: mRNA vaccines can alter your DNA.
  Fact: The COVID-19 vaccine uses new technology called messenger RNA (mRNA). mRNA directs the body to build an immune response to a specific infection. While two COVID-19 vaccines using this technology have been approved by the FDA for emergency use, there are no licensed mRNA vaccines in the U.S. yet. This has generated suspicion in some people. One widely circulated myth on social media claims that mRNA vaccines can alter human DNA. The CDC assures us that this is not true, for the following reasons:
  • The mRNA from the vaccine does not interact with DNA because it never enters the nucleus of the cell where DNA is located.
  • Once the cells use the instructions the mRNA delivers to develop an immune response to COVID-19, they destroy the mRNA.
  • The CDC stresses that mRNA vaccines will be held to the same safety and effectiveness standards as other vaccines that are approved or authorized in the U.S
• Myth: The COVID-19 vaccine is not safe because it was rapidly developed and tested.
  Fact: The pandemic is an emergency situation and many pharmaceutical companies marshalled their resources and had their best teams focus on developing a vaccine. That does not mean they bypassed safety protocols or didn't perform adequate testing. To prove safety and efficacy and receive emergency use authorization from the Food and Drug Administration (FDA), biopharmaceutical manufacturers must have followed at least half of the participants in their studies for at least two months after completing the vaccination series.
  
  The technology for these vaccines, mRNA or RNA, is relatively new but has been researched for more than 10 years. These vaccines were tested in large clinical trials, on tens of thousands of people, to make sure they met safety standards. Many people were recruited to participate in these trials to see how the vaccines offer protection to people of difference ages, races, and ethnicities, as well as those with different medical conditions. This data was reviewed and approved by the FDA, CDC and Western States Scientific Safety Review Workgroup before it was cleared to be given to patients. Based on the data, these vaccines are both safe and effective.
• Myth: If you've had COVID-19 already, you don't need to get vaccinated.
  Fact: Scientists are still learning how long protection from a previous infection, known as “natural immunity,” lasts. According to the CDC, "early evidence suggests natural immunity from COVID-19 may not last very long… People may be advised to get a COVID-19 vaccine even if they have been sick with COVID-19 before." Anyone currently infected with COVID-19 should wait to get vaccinated until after their illness has resolved and after they have met the criteria to discontinue isolation.
• Myth: The COVID-19 vaccine can cause infertility or miscarriage.
  Fact: No, COVID-19 vaccines have not been linked to infertility or miscarriage. A disinformation campaign has been circulating online, claiming that antibodies to the spike protein of COVID-19 produced by the vaccines will bind to placental proteins and prevent pregnancy. Antibodies to the spike protein have not been linked to infertility after COVID-19 infection. This is not scientifically plausible, as COVID-19 infection has not been linked to infertility. Moreover, no other viral infection or vaccination-inducing immunity by similar mechanisms has been shown to cause infertility.
• Myth: You can ditch your mask after you get vaccinated.
  Fact: The vaccine is one tool that can help slow the spread of COVID-19, but in order to end the pandemic, we need to continue with mask wearing, social distancing, frequent handwashing and testing. Here’s why:
  • It will likely take months to immunize the majority of Americans. Until a substantial portion of the population develops resistance to COVID-19 and we reach “herd immunity,” the virus will continue to spread.
  • Protection isn't instantaneous. It typically takes a few weeks for the body to develop immunity after vaccination. If you are exposed to COVID-19 just after receiving the vaccine, your body won’t have had enough time to build up protection and you could still get sick. Taking the proper recommended safety measures will help prevent an infection while your body builds up immunity.
  • While the leading vaccines have proven effective at preventing COVID-19, we don’t yet know whether they can block transmission to others if a vaccinated person is exposed to the virus. Masks have demonstrated their effectiveness at stopping virus particles from infecting others.
• Myth: There are severe side effects of the COVID-19 vaccines.
  Fact: Reactions to the COVID vaccines appear to be short term and do not result in complication or injury. About 15% of people in the test phases of the Pfizer vaccine developed short-term soreness at the site of the injection, and 50% experienced systemic reactions such as headache, chills, fatigue or muscle pain or fever lasting for a day or two. Such side effects are common with many vaccines and are an indication that your immune system is responding as it should.
• Myth: COVID-19 vaccines were developed using fetal tissue.
  Fact: No fetal tissue is used in the making of the COVID-19 vaccines.
• Myth: The COVID-19 vaccine contains eggs and should not be administered to people with an egg allergy.
  Fact: Neither the Pfizer nor the Moderna vaccines contain egg. They are safe for people with egg allergies.
• Myth: Pregnant or breastfeeding women should not receive the COVID-19 vaccine.
  Fact: Despite the categorization of pregnancy as a high-risk condition for severe COVID-19 illness, hospitalization, and mortality, pregnancy remains an exclusion for participation in vaccine trials.

At MarinHealth, and in alignment with UCSF Health and the American College of Obstetrics and Gynecology and the Society for Maternal Fetal Medicine, we recommend that pregnant women have access to COVID-19 vaccines, and that each woman and her healthcare professional engage in shared decision-making regarding her receipt of the vaccine. The theoretical risk of fetal harm from mRNA vaccines is very low.

MarinHealth is following all California state and public health authority guidelines for the distribution of COVID-19 vaccines. We are also working closely with Marin Health & Human Services on distribution procedures and will notify our patients as soon as more information is available. Learn more.

Sherah Bateman is an Infection Preventionist Lead at MarinHealth Medical Center.

A Healthier Immune System for a Healthier You

The job of your immune system is to recognize and address internal threats to your body, such as a viral or bacterial infection or cellular damage caused by sunburn or cancer. This complex network includes organs (spleen, thymus, bone marrow, and lymph nodes) as well as specialized white blood cells (T cells) that travel through your blood stream or lymphatic system, looking for potential threats. When an infectious agent enters the body, your immune system creates antibodies. These antibodies trigger the creation of immune cells specific to that particular pathogen.

As we face the dual threats of COVID-19 and flu season, a healthy immune system is more important than ever. Individuals with compromised or weakened immune systems are more susceptible to infection. Seniors are also at increased risk because the immune system’s response capability weakens with age. Even if you don’t fall into a high-risk group, it makes sense to do all you can to boost your immune system – especially during a pandemic. A few tweaks to your lifestyle can help you strengthen your immune system and boost your overall health.

Eat Right
If you are mindful about what you eat, you already know that a healthy diet is rich in fresh fruits and vegetables, whole grains, lean protein, and legumes, and low in sugar, red meat, and processed foods. Hopefully, you are already eating this way to help ward off heart disease and diabetes. But did you know that this diet is also good for your immune system? That’s because a high-fiber, plant-rich diet supports the growth of beneficial microbes in your gut. Conversely, the typical Western diet, high in sugar, fat, and processed foods, can harm “good” bacteria and suppress their growth. This leads to chronic inflammation of the gut, which is associated with suppressed immunity.

Lower Your Stress Level
Modern medicine’s increasing focus on the mind/body connection has inspired a lot of research into the impact of emotional stress on health. A variety of illnesses, from hives to heartburn to heart disease, have been linked to stress, and studies are being conducted on the effect stress may have on the immune system. If you are experiencing stress (and who isn’t these days?), try to address both the symptoms and the causes:

• The symptoms: Engage in activities that relax or engage you. This could be anything from yoga or walking in nature to indulging in your favorite hobby or even taking up a new one. Close your eyes and listen to music. Laugh more–watch a funny movie or Zoom with friends. Turn off the news. Take a break from worrying with mindful meditation or guided imagery.
• The causes: Learn to say no. Be willing to delegate chores even if you feel like you could accomplish them more effectively yourself. You can’t help others if you’re exhausted and emotionally depleted. Saying yes all the time can leave you feeling resentful and angry, leading to more stress. Try journaling–putting your innermost thoughts on paper can be cathartic. Talk to a spiritual adviser or a counsellor to gain perspective into your situation. Get more tips with this podcast.

Exercise Regularly
Exercise is good for your cardiovascular health. It helps control your weight and lower your blood pressure. And it gets your blood flowing–literally. By promoting good circulation, exercise helps immune cells and antibodies move more efficiently through your body. Another thing you can do to enhance your circulation is to take a cold shower. It’s not the most relaxing activity, but taking a cold shower or jumping into a cold pool has been shown to stimulate circulation.

Watch Your Weight
Fat tissue produces substances called adipocytokines that promote chronic low-grade inflammation and impair T-cell function. What’s more, researchers believe obesity may be a risk factor for the flu as well as COVID-19. There’s no time like the new year for that weight loss program you’ve been meaning to start.

Sleep Better
Sleep has a restorative impact on your body and brain. During sleep, your body releases immune cells and proteins called cytokines. These proteins are signaling molecules that stimulate and regulate your body’s immune response to inflammation and infection. Inadequate sleep reduces your body’s production of cytokines and other immune cells, leaving you more vulnerable to infection. Follow these tips for better sleep:

• Set your body’s internal clock by going to sleep and getting up at the same time every day. Notice when you normally feel tired at night and make that your target bedtime.
• Control your exposure to light. Your body naturally secretes more of the sleep hormone melatonin after dark to get you ready for sleep. Encourage this natural cycle by getting plenty of sunlight during the day. Open the blinds. Work near a window and taking your breaks outdoors. At night, turn off screens within 1-2 hours of your bedtime. The blue light emitted by your phone, tablet, computer, and TV is disruptive to the sleep/wake cycle. Before bed, try reading or listening to music or audiobooks instead of watching TV or scrolling on your phone.
• Avoid caffeine and alcohol in the four hours before your bedtime. Sleep in a dark, cool room (60-67° F).

Try Vitamins
No prescription drug or food supplement can keep you from contracting COVID-19 or any other infectious disease. However, some studies have shown that vitamin C and zinc can help reduce the duration of the common cold. Vitamin D deficiency may make you more vulnerable to infection. However, vitamin D supplements are not recommended if you already have adequate levels of vitamin D. Talk to your doctor before starting a new supplement.

Try Essential Oils
In addition to having a pleasant, soothing scent, eucalyptus and tea tree oils are known to have antiviral properties. Try inhaling them through an oil diffuser. You can also experiment with lavender, which has a calming affect that can help with sleep. Promote relaxation with a few drops of lavender in a warm bath.

Avoid Environmental Toxins
Environmental toxins such as smoke and air pollution can have a negative effect on your immune system. Stay indoors on bad air quality days and avoid polluting your own lungs by smoking or vaping. In addition to the impact on your immune system, vaping or smoking may increase your risk of severe illness if you contract COVID-19.

Your Health Numbers – and Why They Count

You know a lot of numbers. Your social security number. Your zip code. Significant birthdays. Maybe, even in the age of cell phones, a few phone numbers. But what about your blood pressure, blood sugar or BMI? Those are just some of the numbers you need to know to take charge of your health.

The older you are, the more important it is to have regular checkups.If you are healthy and under the age of 50, annual physicals are a good idea. Once you turn 50, consider that yearly checkup mandatory. If you have risk factors for disease or a chronic condition, your doctor may recommend more frequent visits.

Benefits of Regular Checkups
Even if you’re the picture of health, it’s still important to share that picture with your primary care physician (PCP). Regular checkups are a good way to develop an open, honest relationship with your PCP. Here are several important reasons not to skip your annual physical:

• Setting a “baseline” for your health so your doctor can be alert to any changes over time
• Evaluating your risk factors for various medical conditions
• Screening for cancer and other diseases to find and address potential issues before they become serious
• Consulting with your doctor about your lifestyle and what positive changes you should be making
• Regular monitoring of, and help controlling, existing health conditions
• Staying current on vaccinations and screening tests
• Reducing your long-term healthcare costs

Your Checkup–By the Numbers
Part of your physical exam will be an in-depth conversation about your health, medical history, and any recent concerning symptoms. Your weight and blood pressure will be checked and your doctor will do some hands-on examinations, such as palpating your stomach or listening to your heart. He or she will let you know if you are due for a screening or immunization and order any tests you may need. Once you know your numbers, you can get a better idea of your general health:

• Temperature
  98.6 degrees Fahrenheit is the average “normal” temperature, but healthy people can have resting temperatures slightly higher or lower.
• Respiration rate
  This is the number of breaths you take per minute. A healthy adult will take between 12 and 16 breaths per minute. Breathing more than 20 times per minute can suggest heart or lung issues.
• Heart rate
  Your heart rate is the number of times your heart beats per minute. Values between 60 and 100 are considered normal. Generally, a lower heart rate below 60 is a sign of cardiovascular fitness. For example, a healthy elite athlete could have a resting heartbeat as low as 40 beats per minute.
• Blood pressure
  Your blood pressure is recorded as two numbers. The first number is systolic blood pressure, which measures the amount of pressure blood exerts on the artery walls as the heart beats. The second number is diastolic blood pressure. This measures the pressure blood exerts on the artery walls in between heartbeats. Less than 120 over less than 80 is considered normal. High blood pressure (hypertension) is defined as 130 over 80 or higher.
• Body Mass Index (BMI)
  Body mass index (BMI) is your weight in kilos divided by the square of your height in meters. This number is used as a screening method for weight to calculate whether a person is at a healthy weight, or whether they could be considered underweight, overweight, or obese. If you’re feeling brave today, there are a number of BMI calculators on line, including this one from the US Department of Health and Human services:
  • A BMI of less than 18.5: underweight.
  • 18.5-24.9: normal
  • 25-29.9: overweight
  • 30 or greater: obese
• Blood Count
  Your blood is composed of three different types of cells. Red blood cells carry oxygen throughout your body, white blood cells fight infection, and platelets are involved in blood clotting. A blood count measures the number and types of these blood cells present in a cubic millimeter of blood (mm3). This test may be used to evaluate your overall health as well as to diagnose a variety of conditions, such as anemia, cancer, clotting issues, infection, or an immune system disorder
  • The normal range for a red blood cell count is 4.5 to 5.5 million cells/mm3 for men and 4 to 5 million cells/mm3 for women.
  • The normal range for white blood cells is 5000-10,000 cells/mm3
  • The normal range for platelets is 140,000 to 400,000/mm3
  • What is considered a normal count is different in children and pregnant women.
• Blood Sugar
  To screen for diabetes, your doctor may order a fasting blood sugar (FBS), test, also known as a hemoglobin A1C test. Hemoglobin is the part of a red blood cell that carries oxygen to the cells. Blood sugar, or glucose, binds to the hemoglobin in your blood cells. The higher your blood glucose, the more glucose will attach to the hemoglobin in your blood. The A1C test measures the percentage of hemoglobin in your blood that has glucose attached to it. This test reflects your blood sugar levels over the previous 3 months. A normal A1C level is below 5.7%
  • 5.7% to 6.4% indicates prediabetes. The closer that number is to 6.4%, the greater your chance of developing type 2 diabetes.
  • 6.5% or more indicates diabetes.
  • If the test indicates you have prediabetes or diabetes, it will become a routine part of your checkup.

If you don’t have a PCP or you’re looking to make a change, call 1-415-275-3388 to be connected to a MarinHealth Medical Network provider.

Understanding Your Thyroid: Master of Your Metabolism

John’s losing weight, yet he’s eating as much or more as he ever has. He’s been having multiple bowel movements a day, urinates a lot, and is always thirsty. He perspires a lot and is very sensitive to heat. He has mood swings and his wife says he’s getting short-tempered. At night, he has trouble sleeping. He lies in bed and feels his heart thumping rapidly and erratically. What, John wonders, could be wrong?

Jane hasn’t been eating any more than usual, yet she’s putting on weight. Her face looks strangely puffy. She complains of dry skin and constipation and her periods have gotten unusually heavy. Her hair and eyebrows are thinning. She’s often cold and turns the heat up to where it’s uncomfortable for her family. She’s having difficulty concentrating and complains that she just doesn’t feel like herself.

John and Jane’s symptoms are very different, but they’re both due to a malfunctioning thyroid. Located at the base of the neck, this butterfly shaped gland produces hormones that travel throughout your bloodstream, controlling your metabolism and regulating vital body functions including: breathing, heart rate, body weight, muscle strength, menstrual periods, body temperature, cholesterol levels, nervous system function, and development of the nervous system (in infants and children).

Your thyroid uses the iodine in your diet to produces two hormones, triiodothyronine (T3) and thyroxine (T4). (Before 1924, when we began adding iodine to salt, iodine deficiency was not uncommon and could result in an enlargement of the thyroid known as a goiter. An essential micronutrient, iodine also plays a crucial role in brain development during gestation and childhood.) Your thyroid also secretes a hormone called calcitonin, which is involved in regulating the level of calcium and phosphate in your blood.

Hyperthyroidism
John’s symptoms are due to an overactive thyroid, or hyperthyroidism: his thyroid is producing too much thyroxin. This can have a variety of causes, including benign thyroid growths (nodules), inflammation of the thyroid, too much iodine in the diet, and an autoimmune disorder called Grave’s disease.

Left untreated, hyperthyroidism can cause a variety of problems. The heartbeat irregularities it causes can lead to blood clot, stroke, and heart failure. Hyperthyroidism also causes thinning of the bones and osteoporosis. In women, hyperthyroidism may cause fertility problems and pregnancy complications. To treat hyperthyroidism, doctors need to reduce the amount of thyroxin in the body. This can be accomplished through the use of anti-thyroid medications and radioactive iodine. Surgery to remove all or part of the thyroid gland may also be an option.

Hypothyroidism
Jane’s problem is an underactive thyroid, a condition known as hypothyroidism. The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto's thyroiditis. Hypothyroidism can also occur if hyperthyroidism is treated too aggressively and thyroid hormone production is reduced too much. Other causes of hypothyroidism include the after effects of radiation therapy for head and neck tumors, and side effects of certain medications such as lithium.

Hypothyroidism may take years to diagnose because the symptoms can be subtle. Left untreated, it can lead to the development of a goiter. The condition is also associated with depression, slowed mental functioning, high cholesterol (which increases the risk of heart disease and heart failure), and painful nerve damage. Myxedema is a rare, life-threatening result of long-term, undiagnosed hypothyroidism. People with myxedema are extremely sensitive to cold and experience lethargy, extreme drowsiness, and bouts of unconsciousness.

Women with untreated hypothyroidism may be infertile or have babies with serious mental and physical birth defects. Fortunately, all these problems can be avoided by taking regular doses of synthetic thyroid hormone.

Thyroid Cancer
In the US, over 56,000 new cases of thyroid cancer are diagnosed each year, and 1.2 percent of Americans will be diagnosed with thyroid cancer in their lifetime. Women are three times more likely to develop thyroid cancer than men.

Although there are several types of thyroid cancers, some of which are more aggressive, 80% of thyroid tumors are Papillary Thyroid Cancer. This common cancer is highly treatable through surgery and has a nearly 100% cure rate in patients younger than 50. Treatment always involves the surgical removal or all or part of the thyroid gland, sometimes followed by radioiodine therapy. People who undergo total thyroidectomy need to be on a synthetic thyroid hormone for the rest of their lives.

Thyroid Tests
Thyroid function is evaluated through the use of blood tests:

• T4 test
  A high blood level of T4 may mean you have hyperthyroidism. A low level of T4 may mean you have hypothyroidism.
• T3 test
  If your T4 level is normal but it’s suspected you may have hyperthyroidism, your doctor may order a T3 test may to confirm the diagnosis.
• TSH test
  TSH is a pituitary hormone that tells the thyroid how much T4 and T3 to make. A high TSH level is an indication of an underactive thyroid.
  
  A low TSH level generally is a sign of an overactive thyroid. If the TSH test results are not normal, your doctor will prescribe further tests.
• Thyroid antibody tests
  If your doctor suspects you have an autoimmune disorder, such as Grave’s Disease or Hashimoto’s Disease, in which your immune system mistakenly attacks your thyroid, you will be given a thyroid antibody test.
  
  If you suspect you may be experiencing symptoms of hyperthyroidism or hypothyroidism, don’t wait – contact your primary care physician (PCP) to see whether they recommend a blood test to determine next steps. If you need a PCP, call 1-415-275-3388 to be connected to a MarinHealth Medical Network provider.